| NPI | 1467487744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AR 2349) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AR OD1100234) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2016-08-31 |