| NPI | 1396361085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9983TG) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 9983T) |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2025-07-28 |