| NPI | 1790893394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 2128) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.010017) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2012-10-22 |