| NPI | 1982680237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 02304) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046009707) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2014-03-04 |