| NPI | 1033369244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002685A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 2358) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2012-12-10 |