| NPI | 1578637336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046009154) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-009154) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2009-09-23 |