| NPI | 1477655751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 2698) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: TX 2698-TG) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2026-03-23 |