| 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 |