| NPI | 1558244129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG004291) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618003547) |
| Enumeration Date | 2025-07-30 |
| Last Update Date | 2025-07-30 |