| NPI | 1730556580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: AR AR2754) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AR 2754) |
| 152WP0200X Optometrist, Pediatrics (Licence: AR 2754) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: WA OD 60559129) | |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2021-05-13 |