| NPI | 1093740821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046.009850) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2006018214) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2012-02-07 |