| NPI | 1164101200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046.011846) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 0003932) |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2024-08-02 |