| NPI | 1801803044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NM 233) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 05843TG) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2011-05-11 |