| NPI | 1518443472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-002282) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046011966) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2025-04-17 |