| NPI | 1194729624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN OD1240) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN OD01240) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2018-08-30 |