| NPI | 1902598519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: IL 046011876) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH Pending) |
| Enumeration Date | 2023-05-23 |
| Last Update Date | 2024-07-29 |