| NPI | 1972609972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 94-277458-9934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 3858) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2025-06-09 |