| NPI | 1043228380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: TX 02742TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 2742TG) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2010-08-20 |