| NPI | 1760425854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AR 2420) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: AR 2420) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2008-10-23 |