| NPI | 1609878990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002611) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1000DT) |
| 152W00000X Optometrist (Licence: GA 1235) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2011-09-03 |