| NPI | 1730797580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 009301) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 9913TG) |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2020-12-30 |