| NPI | 1891833265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 2708) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901002846) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2011-05-19 |