| NPI | 1215243100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003658A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.010406) |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2014-09-18 |