| NPI | 1568594935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 5453TG) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 411086) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2015-03-09 |