| NPI | 1568627305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 7060853-9934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 7060853-8908) |
| 152WC0802X Optometrist Corneal and Contact Management (Licence: ID ODP-100429) | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2020-03-12 |