| NPI | 1447668553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-002162) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 8515T) |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2019-12-11 |