| NPI | 1437508587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046011016) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD60643254) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2016-06-11 |