| NPI | 1235514084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AR 2726) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 8671) |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2020-10-01 |