| NPI | 1376549378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO T02819) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046008288) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2014-11-18 |