| NPI | 1356788590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 3310) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010645) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2018-04-19 |