| NPI | 1669599403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002462A) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: IN 18002462B) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-08 |