| NPI | 1720393507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901005099) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003655A) |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2024-12-03 |