| NPI | 1528082450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO T03057) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-008597) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-07-09 |