| NPI | 1689104077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003899) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008612-1) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2022-12-07 |