| NPI | 1477805729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8085TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT14430) |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2015-08-12 |