| NPI | 1205927704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 4904T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2088) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2015-08-24 |