| NPI | 1003949090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002759AB) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-009743) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2016-04-15 |