| NPI | 1558777656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046011845) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 074559) |
| 152W00000X Optometrist (Licence: MO 2014031862) | |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2024-05-09 |