| NPI | 1407305097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 33661) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 9078T) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: TX 9078T) | |
| Enumeration Date | 2016-09-24 |
| Last Update Date | 2018-01-17 |