| NPI | 1043733744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AR 2766) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: AR 2766) |
| 152WP0200X Optometrist, Pediatrics (Licence: AR 2766) | |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2019-03-05 |