| NPI | 1043652431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: OR 004352AT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010709) |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2018-07-25 |