| NPI | 1013090513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001717) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 7011T) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: VA 0618001717) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2025-05-27 |