| NPI | 1093913980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 1800940884B) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1720DT) |
| 152W00000X Optometrist (Licence: MO 2007018530) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2019-02-07 |