| NPI | 1811086960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002307A) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: IN 18002307B) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |