| NPI | 1932623709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100424) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 9747TG) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2026-04-03 |