| NPI | 1114929387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 2939T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 2939) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2022-05-27 |