| NPI | 1932208667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG001124) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC 1240) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2021-08-20 |