| NPI | 1457550634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7203T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5747) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2013-11-07 |