| NPI | 1407811979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG001289) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY VUT0068721) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2020-08-31 |