| NPI | 1710982160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 1178) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 3955TG) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2008-02-25 |