| NPI | 1215389812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2489) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003155) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2025-11-21 |