| NPI | 1760583223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 51473169934) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: UT 51473169934) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2015-02-17 |