| NPI | 1396724662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9965T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003130A) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2021-04-30 |