| NPI | 1073297602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG004206) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00732300) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2025-02-11 |