| NPI | 1447371844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 95) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18001707) |
| 152W00000X Optometrist (Licence: SC 560) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2012-09-19 |