| NPI | 1285083055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003582) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2547) |
| Enumeration Date | 2016-06-12 |
| Last Update Date | 2022-05-18 |