| NPI | 1881257004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 3121) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG004113) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2024-01-25 |