| NPI | 1467416818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 0460112373) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 5413T) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2019-01-10 |