| NPI | 1578133211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-011558) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18004274A) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2024-05-13 |