| NPI | 1225409121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 3795) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 2015DT) |
| Enumeration Date | 2015-10-18 |
| Last Update Date | 2023-06-19 |