| NPI | 1407089949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2239) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002295) |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2019-01-18 |