| NPI | 1528797511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 3778) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901005619) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2023-06-13 |