| NPI | 1578751491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010425) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2001020432) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2014-05-01 |