| NPI | 1124281225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DE I3-0011493) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002717) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2026-06-18 |