| NPI | 1801238100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046011522) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2370) |
| 152W00000X Optometrist (Licence: IA 002583) | |
| Enumeration Date | 2013-07-27 |
| Last Update Date | 2021-08-02 |