| NPI | 1568798841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SD 748) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2010002259) |
| 152W00000X Optometrist (Licence: TN 2911) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: SD 748) | |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2021-09-15 |