| NPI | 1134108566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046009911) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18002261A) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2023-02-23 |