| NPI | 1548289010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MS 530) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: LA 997) |
| 152W00000X Optometrist (Licence: TX 3504) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2016-09-12 |