| NPI | 1255563623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002263) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG2263623) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2022-07-21 |