| NPI | 1144689563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8849T) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: TX 9171TG) |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2024-01-25 |