| NPI | 1871799106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2006020342) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.009981) |
| Enumeration Date | 2007-06-24 |
| Last Update Date | 2009-06-04 |