| NPI | 1720419534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-00224) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 8336T) |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2021-05-20 |