| NPI | 1912217951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046.010330) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 21330-875) |
| Enumeration Date | 2010-10-08 |
| Last Update Date | 2022-08-29 |