| NPI | 1548242480 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI RC002397) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MI RC002397) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2023-01-05 |