| NPI | 1467447532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3147) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG001291) |
| 207W00000X Ophthalmology (Licence: MN 3147) | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2020-08-11 |