| NPI | 1588757983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX TX3559) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX TX3559) |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2007-07-09 |