NPI | 1376545038 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002957B) |
Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1408DT) |
Enumeration Date | 2005-08-12 |
Last Update Date | 2011-09-29 |