| NPI | 1801318977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003282) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00677700) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2021-10-07 |