| NPI | 1821525965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 10650496-9934) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: UT 10650496-9934) |
| 152WS0006X Optometrist, Sports Vision (Licence: UT 10650496-9934) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: UT 10650496-9934) | |
| Enumeration Date | 2017-05-19 |
| Last Update Date | 2018-03-07 |