| NPI | 1396820858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2024041934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046008673) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2025-09-16 |