| NPI | 1700444155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 35079TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046011318) |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2023-08-14 |