| NPI | 1609936319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 3923TG) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 3923TG) |
| 152WX0102X Optometrist, Occupational Vision (Licence: TX 3923TG) | |
| 152WP0200X Optometrist, Pediatrics (Licence: TX 3923TG) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2023-03-07 |