| NPI | 1811932775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 2283) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-9396) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2013-04-04 |