| NPI | 1194939769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-009478) |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: IL 046-009478) |
| 152WX0102X Optometrist, Occupational Vision (Licence: IL 046-009478) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2008-09-08 |