| NPI | 1831212075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA1645) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-009321) |
| 152W00000X Optometrist (Licence: DC OP833) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2020-04-12 |