| NPI | 1467861864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046.010895) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2417) |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2023-04-24 |