| NPI | 1790734499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AR 2355) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: AR 2355) |
| 152WP0200X Optometrist, Pediatrics (Licence: AR 2355) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2015-10-05 |