| NPI | 1336101807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG000927) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA AHL2833746) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2023-04-12 |