| NPI | 1902891096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1251) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046007646) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2014-04-02 |