| NPI | 1881387314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2321DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18004395A) |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2023-07-03 |