| NPI | 1437576345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9321T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002888) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2023-12-15 |