| NPI | 1619617685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC6108) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046011601) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2024-12-17 |