| NPI | 1255008462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 3768) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 10378) |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2022-09-29 |