| NPI | 1184711541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003494A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5653) |
| 152W00000X Optometrist (Licence: IN 18003494B) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2023-08-21 |