| NPI | 1699766014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO T03407) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-009101) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2014-10-02 |