| NPI | 1144313891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004307) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 3037-035) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-07-25 |