| NPI | 1184390858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX TG10449) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 3142) |
| Enumeration Date | 2021-08-21 |
| Last Update Date | 2023-02-16 |