| NPI | 1730521840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5283) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002832) |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2022-03-04 |