| NPI | 1013966076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO T02919) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046008326) |
| 152W00000X Optometrist (Licence: IA 077734) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2018-02-21 |