| NPI | 1093500704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2450DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18004608A) |
| Enumeration Date | 2025-04-12 |
| Last Update Date | 2025-07-29 |