| NPI | 1487635942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7505TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG001637) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2018-01-26 |