| NPI | 1306295951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 979) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010982) |
| Enumeration Date | 2016-06-05 |
| Last Update Date | 2019-04-17 |