| NPI | 1982919783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA 002344) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 007633) |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2010-09-17 |