| NPI | 1780679613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 7793397-9974) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 04409T) |
| 152WX0102X Optometrist, Occupational Vision (Licence: TX 04409T) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 04409T) | |
| 152WP0200X Optometrist, Pediatrics (Licence: TX 04409T) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: TX 04409T) | |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2024-05-31 |