| NPI | 1265506224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-002070) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046 007909) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2022-10-26 |