| NPI | 1164090809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003795) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00712200) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NJ 27OA00712200) | |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2022-08-15 |