| NPI | 1497209720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9007TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 9007T) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2021-09-27 |