| NPI | 1205280591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: TX 8791T) |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: TX 8791T) |
| 152W00000X Optometrist (Licence: TX 8791T) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: TX 8791T) | |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2020-06-29 |