| NPI | 1710361159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1989DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003912A) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2025-03-18 |