| NPI | 1205827177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 3637TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: LA 1022) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2007-07-08 |