| NPI | 1548522105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7957) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 7957TG) |
| 152W00000X Optometrist (Licence: MO 2012017229) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: MO 2012017229) | |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2022-05-12 |