| NPI | 1851524318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010282) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 3547) |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2025-09-09 |