| NPI | 1881738532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MS 722) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2525) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2012-07-27 |