| NPI | 1619920535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 4816/T1681) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901003971) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2022-12-27 |