| NPI | 1982796066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003402a) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: IN 18003402a) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2021-04-13 |