| NPI | 1588261309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 10516TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: LA 1928-864AT) |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2023-10-05 |