| NPI | 1619109758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: PA OEG002259) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002259) |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2011-07-15 |