| NPI | 1588184204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-002300) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 9286) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2018-11-15 |