| NPI | 1336695220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003534) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 5161) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2019-09-29 |