| NPI | 1841803632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9997) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 009718) |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2023-04-27 |