| NPI | 1831396548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MT 794) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.009958) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2009-08-12 |