| NPI | 1114071644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046006159) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT5047) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-08 |