| NPI | 1194725382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7322T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 1480) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2012-02-20 |