| NPI | 1295964724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3277) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010262) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2022-09-02 |