| NPI | 1073965943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003182) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA OEG003182) |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2023-08-18 |