| NPI | 1093899890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 07027T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL 4130) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2022-10-25 |