| NPI | 1265407084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 06300T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL R164TA776) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2014-10-21 |