| NPI | 1588977987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003639A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1816DT) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2019-04-11 |