| NPI | 1295966224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8781TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.010293) |
| 152W00000X Optometrist (Licence: MD TA2193) | |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2023-05-16 |