| NPI | 1730185588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AR 2504) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AR OP1100340) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2020-06-30 |