| NPI | 1285612770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 6274) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5287) |
| 152W00000X Optometrist (Licence: TX 06274T) | |
| 152W00000X Optometrist (Licence: TX 6274TG) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 5287) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2022-05-17 |