| NPI | 1770503500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002968) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-009157) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2007-07-08 |