| NPI | 1801806625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG001784) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DE I30001318) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2010-07-13 |