| NPI | 1336136464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OET009052) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 270A00478900) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2018-03-17 |