| NPI | 1881217446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 11768973-1602) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 117968973-9934) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: UT 117968973-9934) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: UT 11768973-1602) | |
| 152WP0200X Optometrist, Pediatrics (Licence: UT 11768973-1602) | |
| 152WP0200X Optometrist, Pediatrics (Licence: UT 117968973-9934) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: UT 11768973-1602) | |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2023-01-26 |