| NPI | 1629322094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: PA OEG003890) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC 4708) |
| Enumeration Date | 2012-11-06 |
| Last Update Date | 2023-05-16 |