| NPI | 1679702096 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7424T) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: TX 7424T) |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2020-03-30 |