| NPI | 1043448053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-001688) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010750) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2020-08-17 |