| NPI | 1609427418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3772) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18004196A) |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2022-05-18 |