| NPI | 1609924745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-008123) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046008123) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2018-06-18 |