| NPI | 1023708054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618003451) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18004412A) |
| Enumeration Date | 2023-05-12 |
| Last Update Date | 2025-01-13 |