| NPI | 1487921276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 9415836-9934) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: UT 9415836-9934) |
| 152WV0400X Optometrist, Vision Therapy (Licence: UT 9415836-9934) | |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2015-08-07 |