| NPI | 1821194259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 5613TG) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 5613TG) |
| 152WP0200X Optometrist, Pediatrics (Licence: TX 5613TG) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2008-10-02 |