| NPI | 1154693570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7794-TG) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: TX 7797-TG) |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2023-04-20 |