| NPI | 1023196755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18001863) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18001863B) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |