| NPI | 1063897494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618002833) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010938) |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2020-08-25 |