| NPI | 1235513292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003221) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NH 904) |
| Enumeration Date | 2015-07-19 |
| Last Update Date | 2024-02-16 |