NPI | 1790984672 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: IL 046010530) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010530) |
152WS0006X Optometrist, Sports Vision (Licence: IL 046010530) | |
152WV0400X Optometrist, Vision Therapy (Licence: IL 046010530) | |
Enumeration Date | 2007-07-12 |
Last Update Date | 2024-05-30 |