| NPI | 1508027277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 2811) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MS 805) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2014-11-19 |