| NPI | 1134190663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 2160) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 997339) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2017-03-14 |