| NPI | 1598965162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MT 3381) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003472A) |
| 152W00000X Optometrist (Licence: KY 1708DT) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2020-12-04 |