| NPI | 1285788745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003437B) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901003924) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2021-08-09 |