| NPI | 1225290406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1811DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003525A) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2025-09-27 |