| NPI | 1831477488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2345) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003522) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2024-05-08 |