| NPI | 1760672331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AR 4014) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2527) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2024-07-02 |