| NPI | 1386808301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MT 1942) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003528A) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2019-11-13 |