| NPI | 1649424037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003553A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901005829) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2025-04-04 |