| NPI | 1437718210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003564) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD 2680) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2021-01-03 |