| NPI | 1154570505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 2905) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003537A) |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2012-04-12 |