NPI | 1770899437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7772TG) |
Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-100215) |
Enumeration Date | 2010-08-19 |
Last Update Date | 2023-07-04 |