| NPI | 1598114530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3536) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.010994) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2023-08-29 |