| NPI | 1871647917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN IN18001630B) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 180012689B) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2015-09-28 |