| NPI | 1578511663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18001493B) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18001493A) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2018-02-23 |