| NPI | 1689682957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AR AR2327) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 5994T) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2012-03-06 |