| NPI | 1073946406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9128) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC4831) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2023-05-16 |