| NPI | 1144371675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002323A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1145DT) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2007-07-08 |