| NPI | 1093828436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist Corneal and Contact Management (Licence: TX 6652 TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 6652TG) |
| 152WP0200X Optometrist Pediatrics (Licence: TX 6652 TG) | |
| 152WS0006X Optometrist Sports Vision (Licence: TX 6652 TG) | |
| 152WX0102X Optometrist Occupational Vision (Licence: TX 6652 TG) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2023-03-07 |