NPI | 1740449529 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004946) |
Additional Taxonomies | 152W00000X Optometrist (Licence: PR 188) |
Enumeration Date | 2008-06-05 |
Last Update Date | 2024-05-10 |