| NPI | 1427098375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA GOO1388) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: PA GOO1388) |
| 152WV0400X Optometrist, Vision Therapy (Licence: PA GOO1388) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2012-02-14 |