| NPI | 1205114006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003705A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 6037) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2012-04-17 |