| NPI | 1881124329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9452TG) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: TX 9452TG) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2019-03-07 |