| NPI | 1114542149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NH 1042) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003662) |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2021-08-27 |