| NPI | 1386604411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2003002151) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046009391) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2024-10-23 |