| NPI | 1720011125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046.009863) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 3056-035) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2009-05-28 |