| NPI | 1356321616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AR AR20723) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AR 2072) |
| 152W00000X Optometrist (Licence: AR AR2072/OP1100009) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2011-12-06 |