| NPI | 1922206036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3143) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 9995) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2023-12-01 |