NPI | 1609514306 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901005772) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.007036) |
Enumeration Date | 2022-05-23 |
Last Update Date | 2025-01-17 |