| NPI | 1538139480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG000145) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ OA002887) |
| 152WV0400X Optometrist Vision Therapy (Licence: NJ TO000580) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2010-01-11 |