| NPI | 1407510035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046011549) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 10407) |
| Enumeration Date | 2021-10-29 |
| Last Update Date | 2023-09-08 |