| NPI | 1871721852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ AZ2140) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010254) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2026-01-02 |