| NPI | 1467186361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003916) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 3.003316) |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2025-11-19 |