| NPI | 1184398026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2352DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18004298A) |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2023-08-02 |