| NPI | 1073008058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: IL 046.011354) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OFC87) |
| 152W00000X Optometrist (Licence: NY TUV008816) | |
| 152W00000X Optometrist (Licence: CA OPT34192) | |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2019-08-23 |