| NPI | 1558890210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: IL 46.011174) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 46.011174) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: IL 46.011174) | |
| 152WP0200X Optometrist, Pediatrics (Licence: IL 46.011174) | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2022-07-21 |