| NPI | 1730342684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 2558) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 7233T) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2013-07-08 |