| NPI | 1487886974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-010310) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 2757) |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2012-06-11 |