| NPI | 1992119838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8568) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-100307) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2014-09-04 |