| NPI | 1942593389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 3401-35) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002501) |
| 152W00000X Optometrist (Licence: NY 007816) | |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2016-06-16 |