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 |