| NPI | 1700212628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046.010730) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4996) |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2013-09-24 |