| NPI | 1689753766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 5479TG) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: TX 5479TG) |
| 152WP0200X Optometrist Pediatrics (Licence: TX 5479TG) | |
| 152WS0006X Optometrist Sports Vision (Licence: TX 5479TG) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2014-05-12 |