| NPI | 1679675334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002790) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046008981) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2021-03-19 |