| NPI | 1891008397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 4851) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002334) |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2021-02-04 |