| NPI | 1992772586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2000DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OE004980P) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2022-07-21 |