| NPI | 1649603572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 9488924-9934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010703) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2016-06-29 |