| NPI | 1093709255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG000600) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA DEG000600) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2022-11-03 |