| NPI | 1083979728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8020TG) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: TX 8020TG) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 8020TG) | |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2026-07-01 |