| NPI | 1366019754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 10778) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC5922) |
| Enumeration Date | 2021-06-05 |
| Last Update Date | 2023-03-07 |