| NPI | 1447209929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001639) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-009695) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2007-07-08 |