| NPI | 1346239142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-008006) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 346-001503) |
| 152W00000X Optometrist (Licence: IL 046008006) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2024-01-25 |