| NPI | 1366492357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046007432) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18002009B) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2023-03-07 |