NPI | 1861912248 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901005729) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2588) |
Enumeration Date | 2017-06-26 |
Last Update Date | 2023-09-12 |