NPI | 1972754182 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901003087) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MI 4901003087) |
Enumeration Date | 2008-10-07 |
Last Update Date | 2024-07-25 |