| NPI | 1396792016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901003935) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MI 16) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2016-06-16 |