| NPI | 1265680177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG-1389) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG1389) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2010-05-26 |