| NPI | 1841811320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2312DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18004388A) |
| 152W00000X Optometrist (Licence: TN 3616) | |
| Enumeration Date | 2020-05-06 |
| Last Update Date | 2023-07-06 |