| NPI | 1083135404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9224TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 9224T) |
| 152WC0802X Optometrist Corneal and Contact Management (Licence: TX 9224T) | |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2019-04-26 |