| NPI | 1407836968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1882) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003558A) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2010-11-30 |