| NPI | 1922089101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002045) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0601800384) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2011-08-08 |