| NPI | 1386836518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010631) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2737) |
| Enumeration Date | 2007-08-12 |
| Last Update Date | 2016-07-01 |