| NPI | 1801895891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001377) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003497A) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2014-02-03 |