| NPI | 1457340705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 3607TG) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: TX 3607TG) |
| 152WP0200X Optometrist Pediatrics (Licence: TX 3607TG) | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2023-03-07 |