| NPI | 1417982828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 01959) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046008687) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2007-10-18 |