| NPI | 1427578681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046.011575) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NE 1467) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2021-12-21 |