| NPI | 1124450986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 5022) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002833) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2014-09-17 |