| NPI | 1629404777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002801) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2388) |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2024-07-10 |