| NPI | 1083810212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 609) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046009940) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2012-12-13 |