| NPI | 1104902923 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 002415) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046009582) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2014-06-17 |