| NPI | 1487798658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG000017) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: PA OEG000017) |
| 152WP0200X Optometrist, Pediatrics (Licence: PA OEG000017) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: PA OEG000017) | |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2024-03-08 |