| NPI | 1932174406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 6851-TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: LA 1293-440T) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 6851TG) | |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2024-06-12 |