| NPI | 1104882745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 6325T) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: TX 6325T) |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2010-04-23 |