| NPI | 1568444917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002299B) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN OD001172) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2010-06-23 |