| NPI | 1245222561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 2928-035) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-009508) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2020-12-27 |