| NPI | 1952324048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-008044) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ 970) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2020-01-24 |