| NPI | 1912070939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 3586) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-007328) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2025-09-09 |