| NPI | 1174691711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA0981) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OET008772) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2018-01-29 |