| NPI | 1841373727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN ODT-757) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN TN0757) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2026-07-21 |