| NPI | 1831537851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA oe00008371t) |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| 156FC0800X Technician/Technologist, Contact Lens | |
| 156FX1800X Technician/Technologist, Optician | |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2013-06-12 |