| NPI | 1760797120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003642) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010413) |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2022-07-21 |