| NPI | 1770887762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 9097355-9934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2956) |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2017-05-09 |