| NPI | 1902945637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 559) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046007517) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-07-08 |