| NPI | 1134178759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-006510) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 2650-035) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2010-09-01 |