| NPI | 1427499227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 3005) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 8195T) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2020-01-30 |