| NPI | 1497714075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AR 2505) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: AR 2505) |
| 152WL0500X Optometrist Low Vision Rehabilitation (Licence: AR 2505) | |
| 152WP0200X Optometrist Pediatrics (Licence: AR 2505) | |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2007-10-18 |