| NPI | 1912762238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046011990) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 11047TG) |
| Enumeration Date | 2024-02-15 |
| Last Update Date | 2025-08-23 |