| NPI | 1316787906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC6466) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG004150) |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2024-06-04 |