| NPI | 1013229442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AR 2693) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.010370) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2014-03-07 |