| NPI | 1932365699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010136) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.010136) |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2009-11-02 |