| NPI | 1689830275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010179) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 13586) |
| Enumeration Date | 2008-08-03 |
| Last Update Date | 2012-04-19 |