| NPI | 1508861311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OE006115T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00437400) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2007-12-04 |