| NPI | 1740594159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9394) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ 2022) |
| 152W00000X Optometrist (Licence: VA 0618002629) | |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2019-05-17 |