| NPI | 1922087261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 10187) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-1007) |
| Enumeration Date | 2006-01-14 |
| Last Update Date | 2022-08-23 |