| NPI | 1386261964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003704) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL TPOP104) |
| 152W00000X Optometrist (Licence: NY TUV009690) | |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2023-05-05 |