| 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 |