| NPI | 1982897005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046009575) |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: IL 046009575) |
| 152WV0400X Optometrist, Vision Therapy (Licence: IL 046009575) | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2007-08-22 |