| NPI | 1487962338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002375) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001990) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2012-10-18 |