| NPI | 1003821760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 02583T) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: TX 02583T) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2009-05-06 |