| NPI | 1518016716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-008290) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 2326-35) |
| 152W00000X Optometrist (Licence: FL TPOP31) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2023-07-19 |