| NPI | 1013961663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DE I3-0001292) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG001481) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2014-09-04 |