| NPI | 1205188844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT003486) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003734A) |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2024-06-13 |