| NPI | 1437536752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 092574) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.010860) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2023-06-02 |