| NPI | 1841632809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002750) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 6210) |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2013-08-21 |