| NPI | 1942439013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002314) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA 2145) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2020-04-21 |