| NPI | 1619974722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002107A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1530DT) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2021-05-07 |