| NPI | 1174557094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG000467) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: PA 0EG000467) |
| 152WP0200X Optometrist, Pediatrics (Licence: PA OEG000467) | |
| 152WS0006X Optometrist, Sports Vision (Licence: PA OEG000467) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: PA OEGOOO467) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2012-11-30 |