| NPI | 1184631475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 109296-9934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18001659A) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-16 |