| NPI | 1881227957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 2444) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 9884T) |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2020-09-24 |