| NPI | 1710057070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 03845T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2086538) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2007-07-08 |