| NPI | 1124124409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 346001515) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18004310A) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2023-10-13 |