| NPI | 1063525780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002689) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DE 13-0001276) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2017-03-13 |