| NPI | 1720170251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG001880) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV005129) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2017-02-01 |