| NPI | 1336453257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002394) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OB009236) |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2024-01-04 |