| NPI | 1770006991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 089178) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046011134) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2018-03-13 |