| NPI | 1467440909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX L9774) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX L9794) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2011-04-05 |