| NPI | 1427822014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 46011839) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18004459A) |
| 152W00000X Optometrist (Licence: FL OPC6780) | |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2025-09-30 |