| NPI | 1134561079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 6192) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901004820) |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2014-05-29 |