| NPI | 1336165083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG - 002166) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OET-008777) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2009-10-03 |