| NPI | 1366424517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 2091TG) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 2091T) |
| 152WP0200X Optometrist, Pediatrics (Licence: TX 2091T) | |
| 152WS0006X Optometrist, Sports Vision (Licence: TX 2091T) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2014-08-13 |