| NPI | 1801388392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003596) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.006680) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2024-02-15 |