| NPI | 1407996119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002574) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY t004297) |
| 152WX0102X Optometrist, Occupational Vision (Licence: PA OEG002574) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: PA OEG002574) | |
| 152WS0006X Optometrist, Sports Vision (Licence: PA OEG002574) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2017-01-09 |