| NPI | 1538154646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 2227) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 2227TG) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2022-10-06 |