| NPI | 1487499406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG004289) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: NJ 27OA00729700) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2026-02-19 |