| NPI | 1386608081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004452) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-009510) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2023-03-07 |