| NPI | 1457404790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003066) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1486DT) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2007-07-08 |