| NPI | 1952717662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1979) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 8506T) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2015-01-27 |