| NPI | 1457621856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7901TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 7901T) |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2012-09-13 |