| NPI | 1841287240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003103A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 3091T654) |
| 152W00000X Optometrist (Licence: IN 18003203B) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2007-07-08 |