| NPI | 1780730333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 6874T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 9164T) |
| 152W00000X Optometrist (Licence: OR 2008T) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2007-07-08 |