| NPI | 1679686810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002553) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 11603T) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2011-12-30 |