NPI | 1720137284 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901003683) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MI 4901003683) |
152WP0200X Optometrist, Pediatrics (Licence: MI 4901003683) | |
152WS0006X Optometrist, Sports Vision (Licence: MI 4901003683) | |
Enumeration Date | 2007-01-10 |
Last Update Date | 2023-02-06 |