| NPI | 1871584144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 2374) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG001552) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2025-02-11 |