| NPI | 1558484121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 3000-035) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.009718) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2008-09-23 |