| NPI | 1386697746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003085) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT001956) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2024-11-04 |