| NPI | 1780789321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: TX 06901TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 6901T) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2012-10-11 |