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 | 2024-10-24 |