| NPI | 1164834834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 9042285-9934) |
| Additional Taxonomies | 152WP0200X Optometrist Pediatrics (Licence: UT 9042285-9934) |
| 152WS0006X Optometrist Sports Vision (Licence: UT 9042285-9934) | |
| 152WV0400X Optometrist Vision Therapy (Licence: UT 9042285-9934) | |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2024-01-18 |