| NPI | 1164414744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 91-111585-9934) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: UT 91-111585-9934) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2007-10-30 |