| NPI | 1720026321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-009938) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901004159) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2008-10-06 |