| NPI | 1649936188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: IL 046-011583) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-011583) |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2021-11-09 |