| NPI | 1144914599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003751) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2893) |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2024-10-08 |