| NPI | 1619976727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: PA OEG000159) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MD TA0619) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2010-07-09 |