| NPI | 1134133960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 6255330-8908) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: UT 6255330-9934) |
| 152WV0400X Optometrist, Vision Therapy (Licence: UT 6255330-9934) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2012-06-25 |