| NPI | 1326397811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010584) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: IL 046010584) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2018-06-05 |