| NPI | 1316508666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003541) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA OEG003541) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2024-07-11 |