| NPI | 1972142545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003850) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2748) |
| Enumeration Date | 2019-12-31 |
| Last Update Date | 2021-10-11 |