| NPI | 1730567140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 10107) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NM 672) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2021-03-05 |