| NPI | 1235239641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 1830) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OET 008758) |
| 152W00000X Optometrist (Licence: NY TUV 006646) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2023-10-26 |