| NPI | 1649369463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 5141T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT001505) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 5141T) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: GA OPT001505) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2014-02-17 |