| NPI | 1730118878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003828A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI MI4901003146) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2021-04-12 |