| NPI | 1437559747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8588TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008910) |
| 152W00000X Optometrist (Licence: IL 046010790) | |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2022-06-01 |