| NPI | 1215805635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 11547) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX 11547) |
| Enumeration Date | 2025-10-27 |
| Last Update Date | 2025-10-27 |