| NPI | 1497794507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901003725) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010193) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2018-08-24 |