| NPI | 1891884771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3018) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046009830) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2024-01-11 |