| NPI | 1679078430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046011567) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 2033) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2021-08-12 |