| NPI | 1336203389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002447A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1200DT) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2007-07-09 |