| NPI | 1033724281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 13508915-9934) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: UT 13508915-9934) |
| Enumeration Date | 2020-09-14 |
| Last Update Date | 2024-09-05 |