NPI | 1639167505 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901002909) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MI 4901002909) |
152WL0500X Optometrist, Low Vision Rehabilitation (Licence: MI 4901002909) | |
152WP0200X Optometrist, Pediatrics (Licence: MI 4901002909) | |
152WX0102X Optometrist, Occupational Vision (Licence: MI 4901002909) | |
Enumeration Date | 2005-10-13 |
Last Update Date | 2007-07-08 |