| NPI | 1710469705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 11155TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO OPT.0003433) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2025-10-27 |