| NPI | 1508548694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA3044) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG004063) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2024-10-31 |