| NPI | 1720164973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 5101015354) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI rv015354) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2019-02-14 |