| NPI | 1629459862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8716TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 8716t) |
| Enumeration Date | 2015-06-13 |
| Last Update Date | 2020-04-27 |