NPI | 1205831245 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901002418) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OH 3071T456) |
Enumeration Date | 2005-06-16 |
Last Update Date | 2009-02-16 |