| NPI | 1316352834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010940) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003852A) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2016-11-17 |