| NPI | 1124717996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 10846TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL T-257-TA-C91) |
| Enumeration Date | 2023-05-05 |
| Last Update Date | 2025-03-26 |