| NPI | 1831161744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG001893) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC 3715) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2014-01-07 |