| NPI | 1548908072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046011887) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2022018185) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2024-12-10 |