| NPI | 1043387277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 4839) |
| Additional Taxonomies | 152WX0102X Optometrist, Occupational Vision (Licence: TX 04839T) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2020-10-29 |