NPI | 1831758358 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901005413) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008913) |
Enumeration Date | 2019-06-08 |
Last Update Date | 2023-11-13 |