| NPI | 1508831074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 4253-TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 04253T) |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2013-07-01 |