| NPI | 1366487118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG 002556) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 12928 TPA) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2012-09-04 |