| NPI | 1790894673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046007795) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO T02601) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2008-04-18 |