| NPI | 1962678268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010052) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2007030965) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2023-12-05 |