| NPI | 1942740212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2017006443) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046011080) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2017-03-06 |