| NPI | 1962666750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010426) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003532A) |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2022-04-25 |