Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901005540 | MI |
NPI | 1013585199 |
---|---|
Provider Name | Dr. Hussein Mouzaihem |
First Address | Dearborn, MI 48126-2779 |
Second Address | Dearborn, MI 48126-2779 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2021 |
Last Update Date | 15/06/2021 |