| NPI | 1285630996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG000110) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: PA OEG000110) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: PA OEG000110) | |
| 152WP0200X Optometrist, Pediatrics (Licence: PA OEG000110) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2011-09-09 |