| NPI | 1144604380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003054) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: PA OEG003054) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2017-05-01 |