| NPI | 1497095244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NM 697) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX ODP-100283) |
| Enumeration Date | 2013-02-14 |
| Last Update Date | 2018-03-28 |