| NPI | 1144311010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DE I3-0001250) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG000774) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2009-12-09 |