| NPI | 1811043938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901003691) |
| Additional Taxonomies | 152WX0102X Optometrist, Occupational Vision (Licence: MI 4901003691) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2016-11-11 |