| NPI | 1861747305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN MN3432) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010599) |
| 152W00000X Optometrist (Licence: MN 3432) | |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2020-12-04 |