| NPI | 1306367131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003386) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV-008607-1) |
| Enumeration Date | 2017-07-01 |
| Last Update Date | 2018-02-20 |