| NPI | 1104899053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-007703) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: IL 046-007703) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2014-10-09 |