| NPI | 1093713273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18001984A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 0954DT) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2020-09-29 |