| 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 |