| NPI | 1295717007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 2954) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 4946TG) |
| 152W00000X Optometrist (Licence: NY TUV006212) | |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2021-03-09 |