| NPI | 1952500159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8563T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046009950) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2016-12-02 |