| NPI | 1831881895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA OPT5724) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046011770) |
| Enumeration Date | 2023-05-25 |
| Last Update Date | 2024-09-10 |