| NPI | 1962841072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5282) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 270A00645900) |
| 152W00000X Optometrist (Licence: PA OEG002772) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2024-03-22 |