| NPI | 1932205440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 6234805-8908) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: UT 6234805-8908) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2015-05-17 |