NPI | 1760725923 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: IL 046010766) |
Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: IL 046010766) |
Enumeration Date | 2013-04-05 |
Last Update Date | 2021-12-09 |