| NPI | 1891426714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003942) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OM00186900) |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2024-07-23 |