| NPI | 1801921259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002172) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002308) |
| 152W00000X Optometrist (Licence: VA 0618001927) | |
| 152W00000X Optometrist (Licence: TX 8619) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2024-02-27 |