| NPI | 1073869434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8067T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ OPT-002680) |
| 152W00000X Optometrist (Licence: PA OEG004095) | |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2024-02-05 |