| NPI | 1073000964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9868TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046011191) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2026-06-09 |