| NPI | 1801498878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18004247A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KY 2211DT) |
| Enumeration Date | 2020-11-13 |
| Last Update Date | 2020-11-13 |