| NPI | 1568611622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3127) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010093) |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2021-05-11 |