| NPI | 1629365093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI ODTG00604) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010482) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2024-02-27 |