| NPI | 1124281225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002717) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 002737) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2013-01-24 |