| NPI | 1740395342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WV 632-OD) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG000825) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2014-01-23 |