| NPI | 1831322825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002552) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 007476) |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2011-12-20 |