| NPI | 1528284346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA oeg001602) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DE I3-0001323) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2017-03-31 |