| NPI | 1114282373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7990TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 7990T) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2012-09-12 |