| NPI | 1306018874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046009824) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 56006889) |
| 152W00000X Optometrist (Licence: PA OEG001984) | |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2023-03-15 |