| NPI | 1861683781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 2727) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA oeg002327) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2020-08-27 |