| NPI | 1508247644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8666TG) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: TX 8666TG) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2022-03-01 |