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 |