| NPI | 1356084222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 403235) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046011712) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2025-07-11 |