| NPI | 1447812284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9800TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 9800T) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2022-06-28 |