| NPI | 1730488776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA PAOEG002352) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2238) |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2016-05-10 |