| NPI | 1295778777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1425) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046009371) |
| 152W00000X Optometrist (Licence: TN 2560) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2012-02-04 |