| NPI | 1801183900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 7805T) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: TX 7805T) |
| Enumeration Date | 2011-07-09 |
| Last Update Date | 2012-09-25 |