| NPI | 1013064385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010945) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: CT 001322) |
| 152W00000X Optometrist (Licence: CT 3.002790) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2016-12-09 |