| NPI | 1750373528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 5377) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 5377TG) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 5377TG) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: TX 5377TG) | |
| 152WP0200X Optometrist, Pediatrics (Licence: TX 5377TG) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2022-04-23 |