| NPI | 1083663488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003817A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO T03411) |
| 152W00000X Optometrist (Licence: KS 1532-3) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2015-10-21 |