| NPI | 1609281880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 9065259-9934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 906) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2017-05-25 |