| NPI | 1780970582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 8015719-9934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 8015719-8908) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2011-06-21 |