| NPI | 1659687242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AR 2658) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: AR 2658) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: AR 2658) | |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2020-06-25 |