| NPI | 1407296940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN IN18003803A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC5184) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2024-09-23 |