| NPI | 1215428222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046011307) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 34008TLG) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2019-08-27 |