| NPI | 1093854325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 4864) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003242) |
| 152W00000X Optometrist (Licence: GA 002153) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: MA 4864) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2023-01-13 |