| NPI | 1831448224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003865B) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4998) |
| 152W00000X Optometrist (Licence: TN 3033) | |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2020-05-26 |