| NPI | 1700635026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 3938) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL 6474) |
| Enumeration Date | 2024-05-17 |
| Last Update Date | 2026-01-29 |