| NPI | 1477619955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG1759) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 5619) |
| 152W00000X Optometrist (Licence: LA 1124) | |
| 152W00000X Optometrist (Licence: WA 3083) | |
| 152W00000X Optometrist (Licence: DE I3-0001255) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2014-09-23 |