| NPI | 1821047515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN TN1741) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 1741) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2026-06-18 |