| NPI | 1104434042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AR 2820) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 3595) |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2020-08-16 |