| NPI | 1942494299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 4880TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 10172) |
| 152W00000X Optometrist (Licence: HI 413) | |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2013-10-23 |