| NPI | 1134122088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 5335TG) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: TX 5335TG) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 5335TG) | |
| 152WP0200X Optometrist, Pediatrics (Licence: TX 5335TG) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2014-03-11 |