| NPI | 1417499823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004986) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: MI 4901004986) |
| Enumeration Date | 2016-11-16 |
| Last Update Date | 2016-11-16 |