| NPI | 1093907818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7162T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: LA 1548-578) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2009-12-30 |