| NPI | 1447392709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2967) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046009640) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-08-15 |