| NPI | 1265621882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7799T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002244) |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2016-12-12 |