| NPI | 1861500175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 1142) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AR 2465) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2021-10-29 |