| NPI | 1528626363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003711) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2759) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2020-08-10 |