| NPI | 1396182457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN OD3433) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010650) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: IL 046010650) | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2022-03-31 |