| NPI | 1528030095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9135) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046008905) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2022-07-21 |