| NPI | 1417951179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 03120T) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: TX 03120T) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2009-07-28 |