| NPI | 1174942197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5407) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010762) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2018-03-17 |