| NPI | 1619260288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003713A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003713B) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2015-07-07 |