| NPI | 1588643878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 1752) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002881) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2019-02-27 |