| NPI | 1689853533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AR 2604) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2565) |
| 152W00000X Optometrist (Licence: TN 2749) | |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2020-09-29 |