| NPI | 1639124761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18004065A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 1239DT) |
| 152W00000X Optometrist (Licence: OH 4279/T170) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2018-03-17 |