NPI | 1942668389 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901005104) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NV 905) |
Enumeration Date | 2016-01-30 |
Last Update Date | 2021-11-30 |