| NPI | 1376512137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO T02999) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-008455) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2012-12-19 |