| NPI | 1316930670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901002604) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: MI 4901002604) |
| 152WL0500X Optometrist Low Vision Rehabilitation (Licence: MI 4901002604) | |
| 152WP0200X Optometrist Pediatrics (Licence: MI 4901002604) | |
| 152WX0102X Optometrist Occupational Vision (Licence: MI 4901002604) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2013-02-08 |