| NPI | 1093802746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4172) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG001836) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2022-10-13 |