| NPI | 1912210527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002385) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ OPT-002821) |
| Enumeration Date | 2010-07-24 |
| Last Update Date | 2025-01-17 |