| NPI | 1205112893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MI 4901003171) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901003171) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: MI 4901003171) | |
| 152WP0200X Optometrist, Pediatrics (Licence: MI 4901003171) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: MI 4901003171) | |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2019-05-09 |