| NPI | 1134136096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 5480TG) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: TX 05480TG) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2020-03-30 |