| NPI | 1437598679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618002462) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010687) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2016-02-08 |