| NPI | 1730273665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7046T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 7046TG) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2025-08-20 |