| NPI | 1922115179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL R-172-TA-809) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901004078) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2017-03-03 |