| NPI | 1598136251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18004225) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 2009DT) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2021-07-09 |