| NPI | 1700299658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010807) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: IL 046010807) |
| 152WP0200X Optometrist Pediatrics (Licence: IL 046010807) | |
| 152WV0400X Optometrist Vision Therapy (Licence: IL 046010807) | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2014-11-03 |