| NPI | 1194138123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 073225) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010786) |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2021-12-08 |