| NPI | 1730138801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046.008556) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 346.000642) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2014-09-12 |