| NPI | 1609859255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003346A/B) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 18003346A) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2024-05-01 |