| NPI | 1730526716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 3122) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002234) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2014-08-26 |