| NPI | 1982794814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 6836T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5435T) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2020-03-26 |