| NPI | 1285366310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2022022991) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.011788) |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2024-03-22 |