| NPI | 1790764454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AR 2549) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NM 558) |
| 152WC0802X Optometrist Corneal and Contact Management (Licence: AR 2549) | |
| 152WP0200X Optometrist Pediatrics (Licence: AR 2549) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2012-09-11 |