| NPI | 1457707192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG00374) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 5141) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2023-04-27 |