| NPI | 1235733700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046011731) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 2210dt) |
| Enumeration Date | 2020-11-25 |
| Last Update Date | 2023-12-27 |