| NPI | 1497232425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2849) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003438) |
| 152W00000X Optometrist (Licence: KY 2161DT) | |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2025-05-06 |