| NPI | 1134108665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003233A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.009540) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2015-10-21 |