NPI | 1962467753 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8044) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OR 3108T) |
152W00000X Optometrist (Licence: CA 7314) | |
Enumeration Date | 2006-04-18 |
Last Update Date | 2018-08-22 |