| NPI | 1144362476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 2611T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OP1477) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 2611T) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL OP1477) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |