| NPI | 1316075070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-008926) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC5779) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2024-05-23 |