| NPI | 1316940950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 2128TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 2128T) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2016-10-27 |