| NPI | 1548524143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010562) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4991) |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2018-08-06 |