| NPI | 1609505940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046.011790) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO OPT.0003796) |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2024-07-21 |