| NPI | 1891046504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 0002976) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002690) |
| Enumeration Date | 2012-09-21 |
| Last Update Date | 2021-06-14 |