| NPI | 1235369844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002211) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003576A) |
| 152W00000X Optometrist (Licence: OH OPT.5850-THER) | |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2016-03-08 |