| NPI | 1194912188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7936T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA 4126) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2022-07-21 |