| NPI | 1073597498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046011151) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN OD0000002583) |
| 152W00000X Optometrist (Licence: VA 0618001169) | |
| 152W00000X Optometrist (Licence: MD TA1728) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2019-05-14 |