| NPI | 1023530151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 3794) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR ATI4411) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2026-04-23 |