| NPI | 1972606325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA-1299) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OET009100) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2019-10-02 |