| NPI | 1154381390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG000521) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: PA OEG000521) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2013-04-18 |