| NPI | 1255408050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG001600) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ TO00385) |
| 152W00000X Optometrist (Licence: DE I20001184) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2007-07-08 |