| NPI | 1114977709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 5424TG) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CO 2278) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 5424TG) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2017-11-16 |