| NPI | 1518982099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046.008870) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: IL 046.008870) |
| 152WP0200X Optometrist Pediatrics (Licence: IL 046.008870) | |
| 152WV0400X Optometrist Vision Therapy (Licence: IL 046.008870) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2016-06-23 |