| NPI | 1568816635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: TX 9337TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2879) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2020-02-05 |