| NPI | 1477105989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18004254) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ OPT-002366) |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2023-01-31 |