| NPI | 1972700995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 6844T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2411) |
| 152W00000X Optometrist (Licence: WA 3654) | |
| 152W00000X Optometrist (Licence: IN 18003109A) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2009-12-06 |