| NPI | 1912437872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003269) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WV 3006-IOD) |
| 152W00000X Optometrist (Licence: KY 2375DT) | |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2026-03-11 |