| NPI | 1639271216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WV0400X Optometrist Vision Therapy (Licence: PA OEG000275) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG000275) |
| 156FX1800X Technician/Technologist Optician (Licence: PA OEG000275) | |
| 152WV0400X Optometrist Vision Therapy (Licence: DE I3-0001218) | |
| 152W00000X Optometrist (Licence: DE I3-0001218) | |
| 152WS0006X Optometrist Sports Vision (Licence: DE I3-0001218) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2014-03-17 |