| NPI | 1235449869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 2986) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002427) |
| Enumeration Date | 2010-10-17 |
| Last Update Date | 2023-07-11 |