| NPI | 1659371094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1700X Technician/Technologist, Ocularist (Licence: MI 5001000030) |
| Additional Taxonomies | 156FX1700X Technician/Technologist, Ocularist (Licence: IL department of labor) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2007-07-09 |