| NPI | 1316169147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG001295) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA MA0491237) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2008-04-30 |