| NPI | 1477592715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 3016) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 02393) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2007-12-21 |