| NPI | 1487173514 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901005425) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 6574) |
| Enumeration Date | 2017-09-09 |
| Last Update Date | 2022-07-21 |