| NPI | 1023239712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 4183TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 3142) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2013-08-19 |