| NPI | 1548255268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 02663T) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: TX 02663T) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 02663T) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2016-11-03 |