| NPI | 1902956493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-009790) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003818A) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2016-05-20 |