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 |