| NPI | 1861614810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046008572) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO TO3050) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-02-19 |