| NPI | 1245276443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 2286TG) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: TX 2286TG) |
| 152WP0200X Optometrist Pediatrics (Licence: TX 2286TG) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2008-03-04 |