| NPI | 1558635748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1894DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003712A) |
| 152W00000X Optometrist (Licence: IN 18003712B) | |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2013-09-26 |