| NPI | 1306844261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618002853) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-008894) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: IL 046-008894) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: IL 046-008894) | |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2023-10-24 |