| NPI | 1275539736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 1843) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1429dt) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2019-12-03 |