| NPI | 1992795132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901003781) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18004210A) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2022-02-10 |