| NPI | 1861443079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-009615) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2004001752) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2014-02-14 |