| NPI | 1730555061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2565) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 9405T) |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2023-11-02 |