| NPI | 1184823049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1774) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID 100-152) |
| 152W00000X Optometrist (Licence: IL 46009990) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2014-10-10 |