NPI | 1396834602 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-009054) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: IL 046-009054) |
Enumeration Date | 2006-10-12 |
Last Update Date | 2020-02-11 |