| NPI | 1598219784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT003141) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 8869T) |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2019-05-29 |