| NPI | 1962422519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2004018249) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046009712) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-09 |