| NPI | 1598174468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 3213) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1968DT) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2024-05-20 |