| NPI | 1972885564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8581) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 6055) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 8581) | |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2022-03-23 |