| NPI | 1144299538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 03553TG) |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: TX 03553TG) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2011-10-25 |