| NPI | 1780772533 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901003954) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MI 4901003954) |
| 152WP0200X Optometrist, Pediatrics (Licence: MI 4901003954) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2018-11-26 |