| NPI | 1912970112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG 001077) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: PA OEG 001077) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2007-11-30 |