| NPI | 1033290895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG000830) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC NC1574) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2023-03-07 |