| NPI | 1154402089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 3093) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046009840) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2011-09-28 |