| NPI | 1306495031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2752) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 9844) |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2020-09-29 |