| NPI | 1891100392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MI 4901004854) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ 1986) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2016-05-26 |