| NPI | 1710456496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5686) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.011261) |
| Enumeration Date | 2018-11-25 |
| Last Update Date | 2019-09-11 |