| NPI | 1508839770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 5959399-8908) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 5959399-9934) |
| 152WV0400X Optometrist Vision Therapy (Licence: UT 5959399-8908) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2016-07-20 |