| NPI | 1164651998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 2957) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001863) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2022-10-24 |