| NPI | 1801101886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1865) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2946) |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2011-11-01 |