| NPI | 1770552242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 2155) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV006353) |
| 152W00000X Optometrist (Licence: PA OE000185) | |
| 152W00000X Optometrist (Licence: PA OEG185) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2024-11-19 |