| NPI | 1386648087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301040778) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4301040778) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2008-07-16 |