| NPI | 1396991402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002113) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 13585) |
| Enumeration Date | 2008-08-09 |
| Last Update Date | 2017-05-01 |