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 |