| NPI | 1669964359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 8194025-9934) |
| Additional Taxonomies | 152WS0006X Optometrist Sports Vision (Licence: UT 8194025-9934) |
| 152WX0102X Optometrist Occupational Vision (Licence: UT 8194025-9934) | |
| 152WC0802X Optometrist Corneal and Contact Management (Licence: UT 8194025-9934) | |
| 152WL0500X Optometrist Low Vision Rehabilitation (Licence: UT 8194025-9934) | |
| 152WP0200X Optometrist Pediatrics (Licence: UT 8194025-9934) | |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2020-02-12 |