| NPI | 1770848384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 4921) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002619) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2016-03-09 |