| NPI | 1194706861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist Corneal and Contact Management (Licence: TX 03313TG) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: LA 930-108T) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2015-01-10 |