| NPI | 1073951612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 002587) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010660) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2021-01-13 |