| NPI | 1275599623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG001557) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL FL2889) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2007-07-08 |