| NPI | 1467736439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8773TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.010927) |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2021-03-24 |