| NPI | 1275938557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8822T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1830) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: SC 1830) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: SC 1830) | |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2015-11-11 |