| NPI | 1023097490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 2447TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA 812) |
| 152W00000X Optometrist (Licence: KY 859) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2007-07-08 |