| NPI | 1609490531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046011525) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: UT 11785522-9934) |
| Enumeration Date | 2020-06-06 |
| Last Update Date | 2021-08-23 |