| NPI | 1376598706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-001291) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003382A) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2025-03-14 |