| NPI | 1962841981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010662) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 3368) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2020-08-24 |