| NPI | 1801023981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003020) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL S-C09-TA-835) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2022-11-14 |