| NPI | 1902841976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG001284) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: PA OEG001284) |
| 152WX0102X Optometrist, Occupational Vision (Licence: PA OEG001284) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2024-10-30 |