| NPI | 1669804589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010719) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003811A) |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2016-03-25 |