| NPI | 1003248907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8312TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 8312-T) |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2022-08-12 |