| NPI | 1336109958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG000875) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00528600) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2007-07-09 |