| NPI | 1588999148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004804) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OR 3448ATI) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: MI 4901004804) | |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2024-03-13 |