| NPI | 1083608608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002135A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18002135B) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2013-01-31 |