| NPI | 1124104229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003240A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003240B) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2019-09-10 |