| NPI | 1831141753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2006037577) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046009246) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2009-04-10 |