| NPI | 1003884172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG-0006826) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 2701) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2013-12-09 |