| NPI | 1699348110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046011652) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SD 774) |
| Enumeration Date | 2021-07-22 |
| Last Update Date | 2023-03-23 |