| NPI | 1841375060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WV 992OD) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG000014) |
| 152W00000X Optometrist (Licence: MD TA1697) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2021-11-05 |