| NPI | 1710965181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG000933) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: PA OEG000933) |
| 152WL0500X Optometrist Low Vision Rehabilitation (Licence: PA OEG000933) | |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2023-05-24 |