| NPI | 1457322455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OE4656T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OE004656T) |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2016-08-23 |