| NPI | 1720646193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 3879-35) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.011310) |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2023-03-09 |