| NPI | 1871509653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 3344AT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-009105) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2026-04-21 |