| NPI | 1174604250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 4037TG) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX TX4037) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2007-07-09 |