| NPI | 1780633008 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046006875) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 002541) |
| 152W00000X Optometrist (Licence: MO T02383) | |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2018-02-23 |