| NPI | 1780609891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 0002321) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046009198) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2019-01-31 |