| NPI | 1588149843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003484) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008890-01) |
| 152W00000X Optometrist (Licence: NJ 27OA00683700) | |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2022-10-26 |