| NPI | 1104813542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL R-332) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046007697) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2023-07-26 |