| NPI | 1093031726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 7710117-8909) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 7710117-993) |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2011-03-14 |