| NPI | 1245300060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003388A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-008297) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2022-04-07 |