| NPI | 1649405218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010245) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2009017112) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2017-06-20 |