| NPI | 1245265545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 4737T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2079) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2012-05-16 |