NPI | 1487634929 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901002484) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MI 4901002484) |
152WP0200X Optometrist, Pediatrics (Licence: MI 4901002484) | |
Enumeration Date | 2006-01-19 |
Last Update Date | 2007-07-08 |