| NPI | 1225280423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 7070612-9934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 7070612-8908) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2014-12-08 |